OCN OCN MCQ 4 — Questions and Answers
Question 1: A patient receiving immunotherapy with pembrolizumab develops a new onset dry cough and dyspnea at rest. The nurse should suspect:
- Hospital-acquired pneumonia
- Immune-mediated pneumonitis (Correct answer)
- Pulmonary embolism from prolonged immobility
- Pleural effusion from disease progression
Correct answer: Immune-mediated pneumonitis
PD-1 inhibitors like pembrolizumab can cause immune-related pneumonitis, requiring prompt evaluation and possible immunosuppressive therapy.
Question 2: Which cancer screening recommendation aligns with current American Cancer Society guidelines for average-risk adults?
- Annual PSA testing for all men beginning at age 40
- Colorectal cancer screening beginning at age 45 (Correct answer)
- Annual mammography recommended starting at age 30 for all women
- Cervical cancer screening every 10 years starting at age 20
Correct answer: Colorectal cancer screening beginning at age 45
The ACS updated guidelines recommend colorectal cancer screening beginning at age 45 for average-risk individuals.
Question 3: A patient's pain is described as burning and shooting down the leg following spinal metastasis. This type of pain is classified as:
- Somatic nociceptive pain
- Visceral nociceptive pain
- Neuropathic pain (Correct answer)
- Psychogenic pain
Correct answer: Neuropathic pain
Burning, shooting, or electric shock-like pain radiating along a nerve distribution is characteristic of neuropathic pain.
Question 4: A patient with cancer-related hypercalcemia of malignancy is most likely to present with which set of symptoms?
- Bradycardia, hypotension, and skin flushing
- Fatigue, constipation, polyuria, and confusion (Correct answer)
- Diarrhea, muscle cramps, and perioral tingling
- Hypertension, peripheral edema, and weight gain
Correct answer: Fatigue, constipation, polyuria, and confusion
Hypercalcemia classically presents with fatigue, constipation, polyuria/polydipsia, and altered mental status (bones, stones, groans, moans).
Question 5: During a blood product transfusion, a patient reports chills, back pain, and dark urine 15 minutes into the infusion. The nurse's priority action is to:
- Slow the transfusion rate and observe for improvement
- Administer diphenhydramine and continue the transfusion
- Stop the transfusion immediately and maintain IV access with normal saline (Correct answer)
- Increase the flow rate to complete the transfusion quickly
Correct answer: Stop the transfusion immediately and maintain IV access with normal saline
These symptoms indicate an acute hemolytic transfusion reaction; the transfusion must be stopped immediately while IV access is maintained.
Question 6: Which chemotherapy agent class is most commonly associated with secondary leukemia as a long-term complication?
- Vinca alkaloids
- Taxanes
- Alkylating agents and topoisomerase II inhibitors (Correct answer)
- Antimetabolites
Correct answer: Alkylating agents and topoisomerase II inhibitors
Alkylating agents and topoisomerase II inhibitors are most strongly linked to treatment-related myelodysplastic syndrome and AML.
Question 7: A patient on long-term opioid therapy for cancer pain reports worsening constipation unresponsive to laxatives. Which agent is specifically FDA-approved for opioid-induced constipation in cancer patients?
- Lactulose
- Naloxegol or methylnaltrexone (Correct answer)
- Senna with docusate
- Polyethylene glycol
Correct answer: Naloxegol or methylnaltrexone
Peripherally acting mu-opioid receptor antagonists (PAMORAs) like naloxegol and methylnaltrexone are specifically approved for opioid-induced constipation without reversing central analgesia.
OCN OCN MCQ 4
A patient receiving immunotherapy with pembrolizumab develops a new onset dry cough and dyspnea at rest.
The nurse should suspect: